Individual
BRIAN J DYKSTRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1234 NAPIER AVE, SAINT JOSEPH, MI 49085-2112
(269) 985-4632
Mailing address
1234 NAPIER AVE, SAINT JOSEPH, MI 49085-2112
(269) 985-4632
(269) 985-4523
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
4301058528
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1346225752
—
MI
05
—
4517335
—
MI
01
—
CA4396
RAILROAD
MI
Enumeration date
12/08/2005
Last updated
01/11/2021
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